Delivering an exploratory near-peer teaching pilot in general practice: a qualitative study of the experiences of GP speciality trainees and medical students

Abstract

Background

Significant challenges exist for ensuring adequate clinical placement capacity for medical students within healthcare. Innovative solutions are needed to address these. Near-peer teaching (NPT) may provide educational benefits which extend to both the learners and the peer tutors involved. We designed and implemented a pilot scheme whereby General Practice Speciality Trainees (GPSTs) in the United Kingdom supervised first year graduate entry medical students across six visits to general practice.

Objectives

To explore the experiences of the GPSTs and the medical students within the pilot study to gain insight into their perceptions of NPT and its delivery within this scheme.

Methods

A qualitative design using focus groups was chosen to explore the participant’s experiences. The focus groups took a semi-structured format based around questions designed to answer the research aims. Seven out of seven (100%) GPSTs and six out of seven (86%) medical students that participated in the pilot scheme took part in focus groups.

Results

Data analysis generated three main themes: near-peer supervision benefits GPSTs and students, reciprocal relationships are significant to the educational experience and the organisation of the project and placements is key to success.

Conclusions

The experiences of GPSTs and medical students were positive, highlighting particular benefit of a longitudinally developed near-peer relationship. If similar findings were replicated on a larger scale and across institutions, this would add confidence for the role of GPSTs in teaching medical students during clinical placements, which could in turn improve training capacity.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12909-026-08637-6.

Background

Medical student exposure to the clinical environment is essential to equip them with the knowledge, skills and professionalism needed to become safe, effective and competent doctors. There are known issues with recruiting sufficient clinical placements for medical students across Europe [1, 2]. The issues are multifactorial, but key are the multiple demands on clinician time alongside the lack of clinicians available to teach [3]. Twenty EU countries reported a shortage of doctors in 2022 and 2023 [4]. Many countries have been expanding medical school places [5] including the United Kingdom (UK) which intends to double medical student places between 2023 and 2031 [6], exacerbating this issue further. This creates the demand for innovative ways of delivering effective clinical training at scale within the pressured healthcare environment.

Near-peer teaching (NPT) is when instruction is given by “another student who is more advanced by at least one year distance, in the same curriculum” [7] and has the potential to increase medical student teaching capacity. It offers benefits for students, notably the opportunity to provide learning experiences that are more tailored to their individual requirements with positive role modelling, while the deliverer enhances their knowledge, teaching skills and leadership [8]. Studies have suggested that medical student tuition delivered by doctors-in-training is well received by participants particularly when teaching instruction is provided but this requires further evaluation [9–11].

Despite the growing literature supporting NPT, it is a resource underutilised in primary care compared to hospital settings [1, 9]. Multiple barriers to primary care doctors-in-training becoming teachers have been identified but Harrison et al. believe underlying these is a cultural attitude that teaching is not an integral part of their training [12]. Several studies have explored the experiences of primary care doctors-in-training supervising medical students though teaching delivery is often by group instruction of prepared sessions [10, 13, 14] or the tutor has a mentor role only [15]. There is a lack of evidence exploring participant’s experiences and perceptions of primary care doctors-in-training providing teaching to medical students on a one-to-one basis in their standard clinic environment and we believe this insight will be valuable towards integrating teaching into their role.

We designed and implemented a pilot scheme whereby postgraduate General Practice Speciality Trainees (GPSTs) in the UK supervised first year graduate entry medical students across six visits to general practice. The GPSTs were supported by experienced educators. Quantitative evaluation found equivalent attainment of learning outcomes whether students were supervised by GPSTs or experienced General Practitioners (GPs) [16].

Our aim in this qualitative study was to explore the experiences of the GPSTs and the medical students taking part in the pilot scheme to gain insight into their perceptions of NPT and its delivery to further understanding of how teaching may be integrated into their roles.

Methods

Study design and setting

Graduate Entry Medical (GEM) students at the University of Nottingham Medical School in the UK undertake Early Clinical Experience (ECE) visits during the first year, which consists of six half-day visits to the same general practice across a ten-month period. The students are supervised individually by an established GP while experiencing a variety of consultations, aiming to embed class learnt skills within a patient setting.

For this pilot study, GPSTs were invited to supervise medical students during the ECE visits instead of a GP. Participating GPSTs attended a 3-hour training session covering ECE aims, teaching and feedback skills prior to the first visit. They were also invited to a debrief session after the first and the final visits. The experiences of all participants were captured through focus groups after completion of all six visits.

A prospective focus group qualitative study was conducted using inductive thematic analysis. Coding focused on the explicit, semantic content of the participants’ accounts with themes developed inductively from these explicit meanings rather than through latent interpretation. Focus groups were utilised to promote discussion and facilitate exchange of experiences therefore encouraging perspective expression. The study is reported in accordance with COREQ guidelines [17].

Recruitment

In the UK, GPSTs complete three years of speciality training after at least two years of post-qualification training. The first two years of speciality training contain a mixture of both secondary care placements and primary care placements with a final year placement at one GP practice. Each GPST has an educational supervisor and a clinical supervisor, the latter supervising their clinical placement. This project was introduced to the 39 GPSTs of the Derby GP Speciality Training Scheme at the end of speciality training year 2 (ST2), with the visits taking place across speciality training year 3 (ST3) September 2022 – June 2023. Participation by GPSTs was voluntary (opt-in). 18 GPSTs attended the teaching training session where the pilot was discussed, with 7 of these going on to participate in the pilot. Reasons for non-participation have previously been reported [16]. Medical student allocation with either GPST or established GP was randomised by an administrator not involved with data collection. Students had the option to move to a GP supervisor if requested (opt-out).

All GPSTs who had supervised students and their respective student were invited by email to separate online focus groups based on their role (GPST or student) and received no compensation for participation.

Data collection

Focus groups were held online using Microsoft Teams during June 2023, after the last supervisory visit. Two focus groups were held for GPSTs and one for students. Focus groups were separated by role to promote familiarity of experiences amongst peers and avoid possible issues with perceived hierarchies. Scheduling was arranged for maximal participation.

The focus groups took a semi-structured format based around questions developed by the project team and designed to answer the research aims: What were your initial thoughts of the project? (for students) or What were your reasons for taking part (for GPST), What was your experience, both good and bad aspects? What are your suggestions for the project? The interview guides are available in supplementary data, S1. The focus groups were facilitated by the module lead who is a GP and known to all participants. All interviews were recorded and transcribed verbatim using Microsoft Teams software before being quality checked and anonymized by a researcher.

Analysis

A thematic approach was taken to the analysis underpinned by the Braun and Clark methodology [18]. Analysis involved inductive coding, focusing on the explicit, semantic content of participants’ accounts with themes synthesised inductively from these codes. This method was utilised due to its flexibility, audience accessibility and alignment with the experience of the research team. After familiarization with the data, two researchers (one clinical, one non-clinical, HE, SS) independently identified initial codes with verbatim illustrations. Codes were compared with differences resolved through discussion. Similar codes were grouped into themes through discussion with a third researcher (HE, SS, JC). The codes and categories were refined through repeatedly reviewing their validity to the original data and discussion with the wider research team. Throughout the analysis, researchers engaged reflexively, considering how their own experiences, perspectives and assumptions might shape interpretation and theme development.

Results

Participants

All seven GPSTs participating had medical students allocated to them for supervision and completed all six supervision sessions. No students requested transfer back to an established GP supervisor from GPST. Seven out of seven (100%) of the participating GPSTs and six out of seven (86%) of their supervised medical students took part in focus groups. Two focus groups were held for GPSTs (with four and three participants) and one for students due to practical considerations. The one non-attendee was due to a scheduling conflict. Focus groups lasted 26–30 min.

Three of the seven GPSTs (43%) and four of the six students (67%) were female. The gender and age characteristics are further described in Table 1.

Table 1.

Characteristics of focus group participants

	Participant group
	GPST n = 7	Medical student n = 6
Gender:
Male	4 (57.1%)	2 (33.3%)
Female	3 (42.9%)	4 (66.7%)
Age (years):
< 25	0      (0%)	3  (50.0%)
25–30	3 (42.9%)	2 (33.3%)
31–35	1 (14.3%)	0       (0%)
36–40	1 (14.3%)	0       (0%)
41–45	1 (14.3%)	1 (16.7%)
46–50	0        (0%)	0       (0%)
> 50	1 (14.3%)	0       (0%)

Thematic analysis

Data analysis generated three main themes: Near-peer supervision benefits GPSTs and students, reciprocal relationships are significant to the educational experience and the organisation of the project and placements. Fig. 1 schematically presents themes, sub-themes and associated categories.

Fig. 1.

Thematic map of themes, sub-themes and categories

Theme 1: near-peer supervision benefits GPSTs and students

Both the GPSTs and the students described many benefits to teaching via near-peer supervision.

Sub-theme: GPST benefits

GPSTs described development of professional skills and gaining personal fulfilment during the scheme. Amongst professional skills, it gave the opportunity to develop leadership, time management and organisation expertise within a supportive environment.

“Time management as well. I noticed, from the very first visit where I was kind of running late and wasn’t sure I was gonna get enough patients in, to the latest one where we had a chat, saw a load of patients and had a good debrief after.” (GPST d)

Several thought their communication skills, both basic and more advanced, had developed. When supervising early medical students, explanations needed to be accurate with simple medical details, similar to patient communication. They also discussed and observed empathy and emotion within interactions. Supervising students encouraged the GPSTs to keep knowledge up-to-date and sometimes triggered them to reflect differently on topics.

“When you practise and they ask you those questions, it does make you think, I need to keep up to date cause you lose a bit of that, I think after graduation.” (GPSTe)

All the GPSTs valued the opportunity for teaching experience. They saw it as being beneficial for their training portfolio, a useful experience to discuss in job interviews and a chance to try teaching and explore their teaching style within a supportive environment. A few would have liked further instruction on teaching methods.

GPSTs also described the personal fulfilment they gained. They felt it was a valuable thing to do and gave them a sense of achievement. They gained enjoyment from seeing a student develop and gain confidence over time.

“just positives in terms of watching the person develop through the year. Sometimes, from a kind of [anonymised] background like that, you’d have kind of lower confidence in yourself. So kind of helping build their confidence as well has also been quite good.” (GPSTc)

All GPSTs enjoyed the experience with some describing it as better than they expected. A few GPSTs expressed the sense of isolation they can feel when consulting and appreciated having a student to chat with and give variety to a clinic.

Sub theme: student benefits

All participants described student benefits to near-peer supervision. They found the scheme less formal than previous teaching which allowed for flexibility and tailored learning. Easier communication by contacting GPSTs directly led to a more personal and consistent experience which aided learning. Most GPSTs had longer patient appointments than established GPs, often 15–20 min instead of 10 min, and a post-clinic debrief session with their own supervisor. Students felt this timetabling was beneficial to their learning.

“It was better than I thought because you get the 20 minute appointments.” (STd)

Besides clinical knowledge, GPSTs were also able to share information from their recent experience of medical career pathways, which students appreciated.

“They had a lot of questions about the job. You know, the actual work itself, simple things like rotas, pay, how does leave work?” (GPSTe)

Participants recognised that student benefits may be dependent on the individual student and the relationship with their supervisor. One student thought their GPST supervisor did not initially have knowledge of their course and learning goals but the consistent and longitudinal nature of the scheme allowed this to be rectified.

Theme 2: reciprocal relationships are significant to the educational experience

Participants described reciprocal relationships as the foundation to the learning experience of the scheme. Both GPSTs and students valued their near-peer relationship while GPSTs were also mindful to the significant influence their relationship with their own GP clinical supervisor and practice had on the experience.

Sub-theme: the near-peer relationship

GPSTs and students described their learning being enhanced by a less formal, more personal relationship than they may have had with a more experienced GP. This was a two-way reciprocal process. Students found GPSTs approachable and responsive to their views.

“I just found it a little less intimidating and a little bit more open to actually talk to them rather than just be scared.” (STb)

“it took me back to when I was a student, that it was hard. It was nice to have that bond.” (GPSTa)

Congruity of learning experiences benefited the teaching and learning processes for participants. GPSTs had taken the same or similar courses to the students which strengthened bonds. Students appreciated seeing the continued professional learning involved with speciality training.

“it was just nice to see that they were comfortable asking for help, cos obviously they’re learning as well. It just opened that up for me as well. Just seeing what that’s like.” (STb)

Students had respect for GPSTs’ knowledge and experience, regarding them as “pretty much full GPs in anything but name”. (STd).

The less formal nature of the relationship may lead students to want more clinical learning experience than the planned objectives. This can lead to the GPSTs managing student expectations which requires support.

Sub-theme: the relationship between GPST, their clinical supervisor and practice

Good communication and a positive working relationship between GPST, their clinical supervisor and the practice is required for the success of the project. GP clinical supervisors should be asked about GPST suitability prior to involvement as student supervision should not negatively impact their own training. A shared understanding of roles and placement expectations amongst all stakeholders is required for success.

“They [clinical supervisors] have a fixed idea of what they think is OK and how they think trainees should approach their work”. (GPSTa)

The day-to-day working pattern of GPSTs can vary between practices. Some have a degree of autonomy to organise their daily timetable, whereas others do not have flexibility to adjust their working pattern when they are supervising students.

“I’m not allowed to arrange my own day in the way that [other GPST] was offered that flexibility to go and do that”. (GPSTa)

GPSTs particularly valued supervising students when they had some degree of autonomy to personalise the experience, building in debrief time or booking suitable patients.

Theme 3: project and placement organisation influence the NPT experience

All participants described aspects of the whole project organisation and logistics of individual placements as key to a successful experience.

Sub-theme: project organisation

For this pilot project, students were allocated to GPSTs with the option to opt-out if it was not suitable. Many said they would not have taken part if it was optional, but once involved, they were happy to continue.

“if I was given the option at the beginning, I would have probably just stuck to the safer option because you don’t know what might happen.” (STe)

“Initially I might have thought that it might be good to be with someone that’d got more experience, but then I found that when I was doing the placements I didn’t feel that was an issue.” (STa)

Some GPSTs would have liked more guidance on teaching methods and structure prior to student sessions.

Sub-theme: placement and appointment logistics

GPSTs and students spoke of difficulties balancing the practice’s and patient’s needs with the student’s educational requirements which could be exacerbated by rigid timetabling. Some students felt they experienced too many telephone appointments, while GPSTs explained they may spend a morning with telephone appointments when the student attended, followed by an afternoon in-person clinic when the student had left. Students often participated in longer 20 min appointments when with a GPST, but then may not see the 6 patients per session recommended in module learning outcomes.

“I think it was a really helpful that the appointment times were longer, but because of the time pressure and the need to get the six contacts, there wasn’t always the time for me to do the patient history and for me to do as much as maybe I’d have wanted to.” (STa)

The longitudinal nature of the placements over 10 months promoted teaching bonds but could overlap with GPST’s own needs as they completed speciality training. Some flexibility of visit timings and organisational assistance was required in these circumstances.

Discussion

Main findings

This qualitative study explored the experiences of both GPSTs and medical students taking part in a pilot scheme whereby GPSTs supervised medical students on a one-to-one basis during their early clinical experience visits in general practice, to better understand their perceptions of NPT and its delivery in this context. It is the first to our knowledge within this setting, making this a novel contribution to the literature. Thematic analysis of focus group interviews identified three key themes; Near-peer supervision benefits GPSTs and students, reciprocal relationships are significant to the educational experience and the influence of the project and placement organisation.

Theme 1: near-peer supervision benefits GPSTs and students

In accordance with previous research [8, 9], GPSTs described development of professional skills in the areas of leadership, time management, organisation, communication and teaching, all of which they perceived as beneficial to their training portfolios and future career. Additionally, they valued teaching as an incentive to self-reflect and keep knowledge up to date. A teaching training session was provided with further debrief sessions available and a few would have liked more instruction on teaching methods. This reflects a recent systematic review which concluded relevant training was a key factor to trainee’s competence and confidence in teaching [9] however formal teacher training is often overlooked in undergraduate and junior doctor curricula [19].

There have been concerns that GPSTs may perceive NPT as a burden, taking away from their own training needs [20]. Despite our participants overwhelmingly describing NPT as a positive experience from which they gained enjoyment and personal fulfilment, we recognise this as a valid concern requiring mitigations.

Students perceived increased learning opportunities from less formal, more flexible and individually tailored teaching sessions available from GPSTs compared to experienced GPs. Congruous learning experiences facilitated student centred approaches to teaching, similar to that found when GPSTs taught groups of students [14]. Students also benefited by GPSTs having longer allocated appointments enabling greater patient interaction and the opportunity to discuss recent experiences of medical career pathways, views reinforced by Baid [21].

Theme 2: reciprocal relationships are significant to the educational experience

GPSTs and students described their learning being enhanced by a less formal, more personal relationship than they may have had with an experienced GP and that it was a two-way reciprocal process. Bonds were formed over shared knowledge of the course and learning experiences, enabled by the longitudinal nature of the project. This has similarities with findings from Smith et al. who explored the mechanisms of learning within the near-peer interactions of different year medical students during a one-to-one longitudinal outpatient placement [22]. They described learning taking place within a “community of practice”. The informal learning culture was found to foster student development. Mutual trust and familiarity built over regular and predictable encounters provided a safe learning environment “to feel comfortable to go into uncomfortable territory”. Similar work also highlights the significance of role modelling within the relationship [23]. Additionally, our work drew attention to the need for support if relationship conflicts occur.

Good communication and a positive working relationship between the GPST, their clinical supervisor and the practice are required for near-peer supervision. Previously, GPSTs were found to have a higher comfort level with undertaking teaching than their supervisors expressed [20]. Good communication will allow full expression of concerns for a mutually beneficial NPT experience.

Theme 3: project and placement organisation influence the NPT experience

Both students and GPSTs expressed occasional difficulties balancing the needs of all stakeholders, which could be exacerbated by rigid student and practice timetabling. Flexible visit timings and organisational assistance from project supervisors was sometimes required for all stakeholders to have a beneficial experience. Thorough planning and supporting resources with freedom of delivery has previously been found to support new near-peer medical student tutors when teaching in the medical school environment [24].

Reflexivity

The focus groups were facilitated by the module lead who is a GP and known to participants. Their role was solely supportive to GPSTS and supervisory as well as supportive to medical students. Their possible impact on participants’ responses was acknowledged during coding and theme generation. The wider research team consisted of clinical educators, a non-clinical educator, clinical and non-clinical researchers to provide wider perspectives and more diverse interpretation to the data.

Strengths and limitations

Study strengths include the utilisation of peer focus groups shortly after completion of visits which limited recall bias and promoted open expression of experiences. The same interviewer for all focus groups minimised potential data collection bias. Students were allocated to GPSTs at random by an administrator, removing selection bias. Transcripts were coded by researchers without knowledge of the participants or any influence on the module thereby reducing bias within the derived themes.

We acknowledge the small number of participants and involvement of only graduate entry medical students may have restricted the experiences captured and may not be indicative of broader or more diverse medical student populations. Voluntary participation of GPSTs led to a self-selected study group, with potentially more positive views. Voluntary participation was deemed appropriate due to the exploratory nature of the pilot, while further studies may evaluate wider participation. The scheme took place at a single institution in the UK, which may limit applicability to other regions and health care systems. Further research looking at the implementation at other institutions would help better understand transferability. Students placed with established GPs were not invited to focus groups, meaning there was absence of a direct comparator, which could be explored in any further research. We acknowledge the influence a known focus group facilitator may have had on responses. With a supportive role to GPSTS, discussions were considered to be open and opinions freely expressed whereas their supervisory role to students may have restricted expression. This may also be reflected by more codes deriving from GPST interviews than medical student interviews despite the same number of participants. Future work should seek to overcome potential bias in gaining medical students’ views.

Implications for practice

This scheme highlighted many benefits to GPSTs and students. GPSTs therefore should be suitable supervisors if adequate, ongoing support is provided. There needs to be attention to organisation of scheme at practice and trainer level. Similar schemes have the potential to increase capacity but this needs to be assessed on a wider scale. This scheme involved early years students who were in the main observing consultations meaning there were minimal infrastructure considerations, this may become more of an issue with senior student supervision. Although the findings here are context-specific, the NPT framework could be adapted by other institutions by applying its principles to local curricula and resources.

Conclusions

This qualitative study aimed to explore the experiences of GPSTs and the medical students after a longitudinal one-to-one placement in general practice to better understand their perceptions of NPT and its delivery in this setting. Our results demonstrate that the experiences of both GPSTs and medical students were positive, highlighting particular benefit of a longitudinally developed near-peer relationship on the learning experience. The findings add to the growing evidence of the suitability for primary care doctors-in training to supervise medical students. If similar findings were obtained when implemented on a larger scale, across institutions, this would give confidence in the use of GPSTs in teaching medical students on clinical placements, which in turn could help towards the known capacity issues within medical education.

Abbreviations

ECE

Early Clinical Experience

GEM

Graduate Entry Medicine

GP

General Practitioner

GPST

General Practice Speciality Trainee

NPT

Near-peer teaching

ST

Student

UK

United Kingdom

Authors’ contributions

JC was involved in conception of the project and recruitment of GPSTs. JC facilitated the focus groups and acquired the focus group data. HE analysed the focus group data under the guidance of EW and JT. All authors were involved in interpretation of the data. JC and HE drafted the manuscript. All authors read and approved the final manuscript.

Funding

Not applicable.

Data availability

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

Ethical approval was obtained from the University of Nottingham Research & Ethics Committee (FMHS 159–1122) (05/01/2023) and the research adhered to the Declaration of Helsinki [25]. All participants were informed of the nature and scope of the wider research study by email and written informed consent to participate obtained. Separate informed consent was obtained by email for focus group participation with the information repeated verbally at the time of participation. The participants were assured that information collected during the study would be anonymised, stored securely and used solely for the purpose of this research in accordance with University of Nottingham GDPR governance policies. All participants had the opportunity to withdraw at any time and if requested, data erased prior to anonymisation.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.